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1921 A Survey of the Schools by Teachers No. 1 



MINIMUM HEALTH 

AND SANITATION STANDARDS 

IN SCHOOLS 

By 
LOUIS I. HARRIS, M. D., Dr. P. H. 

Director, Bureau of Preventable Diseases 

Department of Health 

City of New York 



An Address delivered before The Teachers Union 
of the City of l^eiv York 



PUBLISHED BY 

THE TEACHERS UNION OF THE CITY OF NEW YORK 
Local 5, American Federation of Teachers 

70 Fifth Avenue, New York 



Price 10 Cents 



INTRODUCTION 

N the month of January, 1921, the Teachers Union of the City of New York began 
a survey of the public elementary and high schools of the municipality. An appli- 
cation to the Board of Superintendents for a leave of absence without pay for the 
President of the Union has been made as a preliminary to undertaking the survey. But 
the application was refused on the stated grounds that there was no need of a survey 
of the schools and that the person applying for the leave of absence was not qualified 
to undertake a survey. 

Inasmuch as the union movement among teachers is characterized by a growing 
desire on the part of teachers to improve the conditions under which the work of 
teaching is carried on, the Teachers Union decided to go ahead with its plans. 
Accordingly, it was decided by the Union that the President should resign his position 
as teacher in a high school. The resignation was accepted January 3, 1921. 

The letter of resignation dated December 14, 1920, contains this statement quoted 
here to indicate the scope of the inquiry proposed: "Among the conditions inquired 
into should be the following: The physical conditions, the conditions relative to ad- 
ministration, the conditions relating to teaching. In addition, I believe it is important 
that studies be made of the quality of our ideals in relation to the prevailing schools 
of educational thought. In this connection, we should know the source of the moral, 
the social, the civic and the professional inspiration of our teachers. The study of 
these conditions in relation to the product as shown in the output of our schools and in 
the quality of our citizenship should give us important leads for fundamental changes." 

Those who are familiar with conditions in the field of public education know that 
the teachers themselves have developed few standards of a professional nature. What- 
ever standards there are have been set up by those who control. They are modified 
scarcely at all by those who do the work of teaching. In general this state of affairs 
has tended to establish among teachers a feeling of indifference to conditions of work. 
In the City of New York many teachers seem to believe that certain unfavorable con- 
ditions under which they endeavor to do their work are unavoidable, and make no 
effort to have them corrected. Doubtless a large number of teachers do not even 
desire better conditions, because of ignorance of higher standards than now prevail. 

The Teachers Union since its organization in March, 1916, has been associated 
with the union movement in industry, and has become convinced that the development 
of standards in education must take a path similar to that followed by the workers. 
If conditions are to be improved, the effort in that direction must be made by the 
persons who are in direct contact with the conditions. Democracy in education, as in 
industry, cannot exist without the organized and democratically controlled effort of 
the workers. 

Improvement in the conditions under which work is done leads logically to im- 
provement in the product of work. The Teachers Union has striven to make clear 
to the teachers the need of professional standards that will aid all those who teach in 
producing work that has marks of high educational and social value. The Union 
believes that the first step in the direction of educating the members of our profession 
to think in terms of standards is to set before teachers such health and sanitation 
standards as those offered in this publication. The author of the article printed here- 
with was for several years Director of the Division of Industrial Hygiene of the New 
York City Department of Health. In that position, and as teacher of Industrial 
Hygiene in Bellevue Medical School, as well as in his present position in the Depart- 
ment of Health, Dr. Harris has been able to speak with authority on the subject of 
standards of health. 

The distribution of this pamphlet among the members of the Teachers Union will 
be followed by a study of the physical conditions prevailing in the schools covered by 
our membership. The facts thus collected will be prepared as a publication of this 
School Survey series, and will be used for the purpose of arousing the public to the 
realization of the actual physical environment in which children spend their days in 
school. A serious effort will be made to carry out a study of the health of teachers 
along the lines suggested by Dr. Harris. Preliminary inquiries made of our members 
indicate that it will be possible to obtain the consent of at least one thousand teachers 
to agree to having exact studies made of their personal health in relation to their 
work as teachers. 

The Teachers Union expects that the establishment of improved standards of a 
physical nature in the schools will not be attained until the teachers themselves have 
increased their interest in the matter of needed changes. Similarly, in the administra- 
tion and in the teaching standards, which have already been given some attention by 
our organization, hard work and constant agitation will be necessary to the attain- 
ment of our aims. 

This pamphlet is offered to the public as a social contribution by teachers to the 
work of preparing children for life. Other contributions made with the same end in 
view will follow as rapidly as means and time make possible. 

The Teachers Union of the City of New York. 
•*'. • (^t^^Y R. LINVILLE, President. 

'•'" "Onblishef 



MINIMUM HEALTH AND SANITATION STANDARDS IN SCHOOLS* 
LOUIS I. HARRIS, M.D., Dr. P. H. 

Director, Bureau of Preventable Diseases, Department of Health, 
City of New York 

IN this address it is aimed to present an outline of minimum sanitation standards 
for the protection of school children and teachers. The contributions made 
by various observers to our knowledge of the sanitary and working condi- 
tions in schools and their effects upon the health of the pupils and teachers 
are very meagre. Much valuable information is available with reference to the 
health of school children as a result of school medical examinations and special 
studies. Aside from Terman's "The Teacher's Health," there have been no very 
substantial, scientific or comprehensive contributions on the subject of the health of 
teachers. The health of the teacher determines not only the quality of his services 
to the individual and to the community as a whole, but is also of grave concern to 
every parent as an index of sanitary conditions in the school environment. 

A note of caution should be sounded with respect to certain fallacies that 
ers, particularly those dealing with the mortality rate from various diseases among 
underlie the statistical studies which have been made of the health of school teach- 
those so employed as contrasted with other occupational groups. The reports of 
the Schlockow Committee and of Dr. L. I. Dublin on this subject do not present 
typical cross-sections which give a fair basis for judgment as to the degree to 
which the teaching profession is a hazardous one. These studies present but a 
fragmentary picture covering a limited period of time, and in the main, a record 
of those illnesses and diseases exclusively, for which the regulations provide com- 
pensation or, which, for other special reasons, come under official notice. 

Those who venture to offer definite conclusions with reference to the presence 
or absence of hazards in the school environment and the number and causes of 
illness and deaths are prone to make the same serious error that frequently is 
noted with respect to military statistics. The cases of illness and of disease which 
are published in military statistics are, by and large, those which cause a relatively 
marked disability. At the close of the recent war, morbidity and mortality statis- 
tics were published showing the incidence of disease and of deaths, and their 
causes, in the army. Since then, however, through various sources — official and 
unofficial — much additional information has come to light about the many cases 
of so-called "irritable heart," of mental disease, as well as of thousands who since 
the close of the war have come to official notice as the subjects of tuberculosis, 
or as suffering from the sequelae of poison gases, under-nutrition, severe physical 
labor, and exposure. These as well as other conditions have been responsible for 
much illness or disability which did not appear in official records. Those who 
continued in the trenches despite certain more or less significant illness were also 
never reported. Likewise, with respect to the statistical studies of teachers. 

The Kind of Study That is Needed 

What is now required is a study that will reveal not only the cases of illness 
in teachers which come to official notice, but also a large number not officially 

• Address delivered before The Teachers Union, March 17, 1921. 



4 Survey of the Schools by Teachers 

noticed, which have a serious effect upon the physical and mental well-being 
of teachers, affecting their capacity to teach and the quality of their work. We 
should know how many of these teachers persist in remaining on active duty 
in the trenches, so to speak, despite ailments and illnesses which affect them, and 
v/ho thus really "mahnger" or pretend to the possession of health which they do not 
have. Such studies should cover an adequate span of years and should subdivide 
the teachers who form the subject of such studies, not only according to sex, but 
into the various age-groups, so that we may record whether they are subject to a 
variety of diseases which are directly or indirectly caused by their vocation, and 
particularly whether such diseases appear in a relatively early age or group. In 
other words, whether they suffer prematurely from the effects of fatigue, from 
any specific disease, or from the result of exposure to unsanitary conditions. The 
cases of illness should be studied and referred back, if possible, so as to learn 
whether there is an association between a particular type of illness or disease or 
cause of death, and the conditions obtaining in respective schools. 

Such studies should aim to determine how much of the "labor turnover" or the 
desertions from the ranks of the profession are due to discomfort or ill health 
induced by the nature of the work. As the result of their experience, industrial 
hygienists invariably ascribe a certain amount of labor turnover to conditions in 
industry which have a relation to health and comfort. In such studies, emphasis 
should not be laid merely upon the number of deaths, or even upon the number of 
cases of illness from various causes, but special consideration should be given to the 
question whether the work in a given group or type of teachers is compatible with 
"keeping fit" so as to enable the teachers to enjoy normal and healthful life. Fur- 
thermore, such studies should not be rated as complete unless they are based on the 
most careful clinical observation of a large number of teachers over a considerable 
period of time, so as to measure more accurately the effect of the work that they are 
doing upon the general powers of resistance and general well-being, as well as upon 
the nervous system, the heart, the digestive system, the lungs, and the other parts 
of the body. Due consideration should of course be given to any personal habits, 
unusual home conditions, or to a physical condition antecedent to entering the pro- 
fession, which may have exerted an influence in causing certain clinical conditions 
that may be observed in the course of such studies. 

In the slow evolution of things, the necessity for the medical examination and 
super\asion of school children has become recognized by civilized nations and by 
the more progressive communities. We must be sure that school children who are 
being medically examined for the discovery and correction of physical defects are 
not in the meanwhile subject to environmental conditions within the school which 
may in greater or less measure be responsible for the development of such physical 
defects and disease. Therefore, the sanitary conditions of the school environ- 
ment and the health of the school teacher who comes in immediate contact with 
school children are interlocked, and must be most carefully considered together. 

The school teacher who suffers from a communicable disease, such as pul- 
monary tuberculosis, is a grave menace because of the intimate contact with rela- 
tively large numbers of children, who, as medical men well know, are most subject 
to tuberculous infection. Therefore, the sanitary conditions prevailing in schools 
which may favor the development of tuberculosis or other communicable dis- 
eases are of very great significance from the standpoint of their influence upon 



Minimum Health and Sanitation Standards 5 

pupil and teacher. Moreover, ill health may have a very serious effect upon the 
disposition and temperament of school teachers, and may seriously influence their 
work in molding the character of the pupils under their care. 

Fatigue 

With our gradual advance in medical knowledge has come a better understand- 
ing of the particular significance of fatigue, not only as the cause of mental 
strain, of so-called "neurasthenia," but also as the cause of a direct or indirect 
reaction through nervous channels upon various organs and glands in the body, 
the complex actions of which are delicately balanced and correlated. A disturbance 
of one such organ or gland may radiate to many others, and cause perversions of 
circulation, and of many of the vital processes of life. We have also come to 
appreciate the fact that the powers of resistance of the body, which determine 
how susceptible an individual may be to any one of the communicable diseases, 
are very seriously affected and undermined by fatigue. Fatigue, therefore, aside 
from causing certain nervous or mental disorders may play a serious role in 
influencing the development of a variety of organic diseases, or in predisposing 
individuals to communicable diseases. 

Fatigue is not only determined by the number of hours of work, or by the 
number of days of work each week, but depends to a great degree upon the char- 
acter of such work. It is especially induced by the necessity of concentrating, 
and taxing the attention, the memory, and general alertness. For example, every- 
one who has had experience in studying fatigue in industry has given attention 
to the strain upon the girls engaged in the process of weaving who may have to 
take care of twelve or even more looms at a time, or upon girls doing similar 
types of work which require them to attend to from twelve to thirty or forty units 
of machinery at one time. In like fashion each pupil may justly, be regarded as 
comparable to a unit of machinery, insofar as it taxes and strains the mental and 
visual faculties of the teacher, and causes a physical effort on the part of the 
teacher in the course of teaching, disciplining and speaking to a large group. No 
one, except those who have done public speaking or teaching continuously for pro- 
longed periods, can appreciate the physical as well as the mental strain which con- 
stant loud speaking may cause. Fatigue is greatly aggravated by any insanitary 
condition which may obtain in the school on classroom. Excessive heat, poor 
ventilation, inadequate lighting, dust in the air — all of these, and many other 
environmental factors tend to aggravate as well as to induce fatigue. 

In industry it has frequently been possible for experts who study fatigue, to 
recognize its presence and to estimate its degree by the amount of spoiled work 
which is produced by those who are suffering from this condition. Unfortunately, 
this test cannot be applied in dealing with that intangible product of the teachers' 
labors — namely, knowledge and character development. It would be of inestim- 
able value if the "spoiled work" of teachers, as the result of the fatigue from 
which they may be suffering, could be even approximately estimated. It would 
be most valuable to know how many children were unfavorably influenced with 
respect to the acquirements of character and knowledge, or were "spoiled" or 
marred in the process of their making as the result of fatigue in the teacher. Un- 
fortunately, it has been found that workers themselves are not always conscious 
of fatigue, nor are their sensations a reliable guide as to its presence. For these 



6 Survey of the Schools by Teachers 

reasons too much stress cannot be laid upon the importance of having proper and 
sanitary environment, so that children who spend a considerable part of their 
growing years in the school environment shall not be unfavorably affected by 
insanitary conditions — and teachers likewise — and so that conditions of work shall 
not be productive of fatigue which may cause a marked susceptibility to dis- 
ease in both pupil and teacher, or be reflected ultimately in the character of the 
children who come out of our schools. 

Occupational Diseases of Teachers 

While tuberculosis is not a conspicuous hazard in the teaching profession, it 
must nevertheless be reckoned with as a most important disease, to which teachers 
are in a fair measure exposed and subject. No adequate scientific work has yet 
been done under proper medical direction to ascertain to what extent the physical 
condition of teachers before they enter upon their profession, or the home con- 
ditions, the school environment, or the exposure to conditions which may favor 
the development of bronchitis or respiratory infections, as well as personal habits, 
may each contribute to call into activity a latent tuberculous infection which most 
adults harbor, and cause an active process to be lighted up. In the study made 
by Dublin of morbidity and mortality statistics which were available through 
official sources, he pointed out that only thirty-eight teachers had pulmonary 
tuberculosis during 1915. It is reasonable to suppose that the thorough and sys- 
tematic physical examination of our school teachers would have revealed a very 
considerable amount of tuberculosis that had not previously been recognized or 
disclosed. Pulmonary tuberculosis, even if there be but thirty-eight cases of it 
among school teachers, is a much more grave condition in members of this pro- 
fession who come in such direct and intimate contact with great masses of children 
tlian is indicated by its numerical prevalence. Especially because, as already men- 
tioned, childhood is the age of greatest susceptibility to tuberculosis, the tuber- 
culous teacher is potentially a distributor of such infection to all of his or her 
pupils. 

Other Occupational Diseases 

While there is much that is indefinite with reference to the prevalence of 
specific occupational hazards or diseases among teachers, because of the fallacious 
methods of inquiry upon which we have heretofore had to depend for our statis- 
tical knowledge, one may, however, state quite definitely on the basis of statistical 
evidence that tuberculosis, chronic laryngitis, or "speaker's voice," nervous dis- 
orders which assume a variety of forms, especially so-called "neurasthenia," diges- 
tive disorders, respiratory infections (notably acute bronchitis, influenza, pneu- 
monia and follicular tonsilitis), as well as defective eyesight, may be properly 
regarded as occupational diseases incident to teaching. 

Neurasthenia and other nervous disorders have already been referred to as 
being very frequent among school teachers ; — it is fair to assume this prevalence, 
not only on a statistical basis but also because they have been found to be most 
markedly prevalent among skilled workers in various other professions and trades. 
As already briefly indicated, the nervous manifestations may cause reflex dis- 
turbances as of the digestive organs, or the generative organs in females. Siich 
nervous disorders may be temporary in character, or they may be firmly and per- 



Minimum Health and Sanitation Standards 7 

manenlly established. Acute infectious diseases would no doubt be found to be 
relatively frequent, if the health of teachers was studied, not merely by means of 
the compilation of inadequate statistics, but by continuous medical supervision, 
and by follow-up to ascertain the causes of absence. The intimate contact of 
teachers with children, who, as is well known, are especially susceptible to a 
variety of acute infectious diseases, makes them likely to contract such diseases. 

Chronic laryngitis has been very frequently found among teachers, as indeed 
among others who are compelled to use their voice a good deal. This results in 
hoarseness and very considerable discomfort, and may be followed by a secondary 
bronchitis, resulting from extension of the inflammatory conditions affecting the 
larynx and the pharynx. Laryngitis, and acute or chronic bronchitis, are in a 
measure capable of being caused as the result of exposure to chalk dust. Dr. 
George M. Kober in his latest work (Kober & Hanson's Occupational Diseases) 
has particularly emphasized the hazard from chalk dust not only with relation to 
bronchitis, but with reference to the development of pulmonary tuberculosis. In 
reviewing the prevalence of tuberculosis in teachers which some writers have 
reported as being comparatively low, he says : "Higher rates for tuberculosis have 
been reported by Schmidt of Dusseldorf (than death rate of 1.3 males and 1.55 
per 1000 females in Bavaria), and our American statistics also indicate that school 
teachers are slightly more liable to tuberculosis than members of the other learned 
professions. 

"This is doubtless due to indoor life, confinement in badly ventilated school 
rooms and the presence of dust. Diseases of the nervous system and uterine 
organs are also quite common, and teachers will do well to insist upon proper 
seats, absolute cleanliness of the school room, fresh air schools, or at least copious 
ventilation, and susbstitution of wet for dry methods of removing chalk mark- 
ings." 

Defective eyesight is very commonly found among school teachers, and while 
no doubt it is in a measure due to the strain upon the eyes in the course of prepa- 
ration for their profession, it may also, however, be produced in a very consider- 
able number of cases by the strain to which sight is subjected in the course of 
routine work, and particularly by defects of lighting. While there is insufficient 
evidence to warrant many of the statements which have been made with reference 
to the prevalence of certain diseases among teachers, one may nevertheless venture 
to assert that thorough and frequent medical examination of many teachers over 
an extended period of time, with a scientific method of health-bookkeeping, would 
show the existence of numbers of organic defects which have not thus far been 
recognized or justly appraised. Surely, the glib dismissal of diseases said to be 
associated with teaching which has sometimes marked the reports of certain 
studies based on manifestly inadequate statistical evidence, is not scientific and 
has tended, unintentionally no doubt, to treat these moot points as if they had 
been settled conclusively and for all time. 

In marshalling statistics one must be cautious in their use and in their selec- 
tion that they may not consciously or otherwise be pressed into service to bolster 
up fixed preconceptions. As illustration one might balance against some statistics 
which have been published to discount the existence of occupational hazards in 
the teaching profession, the report contained in Bulletin No, 106 of the U. S. 
Bureau of Census for 1909 in which it is shown that in certain age-periods the 



8 Survey of the Schools by Teachers 

mortality of female teachers from certain infectious diseases is higher than for 
the general mass of females in industry; and from organic heart diseases the 
mortality is higher for the ages 25 to 44 years than among the general workers 
of the same age-groups; also the mortality is higher for a kidney disease in the 
age-group 35 to 44 years for female teachers than it is for general workers. 

DEATHS OF PERSONS IN OCCUPATIONS 



Teachers, Professors in 


Beaths 


Per 


Cent. 


of 


All Cases 


at Specified Aees 


Colleges (Females) 


All Causes 


TUBERCULOUS LUNGS 


APOPLEXY AND PARALYSIS 






Teachers 


General 




Female 


Teachers 


General 


Female 








Workers 




Workers 






"Workers 


Workers 


25 to 34 years . ... 


. 269 


38.7 


31.0 




35.7 




1.5 


1.2 


1.3 


35 " 44 " 


. 194 


19.1 


23.6 




21.3 




4.1 


2.7 


4.0 


45 "54 


. 167 


7.8 


14.4 




10.2 




7.8 


5.9 


8.4 


55 " 64 " 


. 130 


7.7 


7.5 




5.6 




6.9 


10.1 


12.3 



760 



HEART DISEASE 



PNEUMONIA 
(All Forms) 



BRIGHT' S DISEASE 







m 
11 
Si 
o 


— m 


1^ 


O 




"m CD 


m 

(V 

o 


















S o 


0) o 












^ 


o| 


fa^ 


H 


0^ 


fa^ 


in 


O^ 


fe^ 


25 to 34 


years . . 


.. 5.2 


4.8 


6.4 


5.2 


7.4 


5.7 


2.6 


4.0 


4.6 


35 " 44 


(( 


.. 9.3 


7.7 


10.5 


11.9 


9.5 


6.4 


7.2 


6.6 


7.7 


45 " 54 


« 


.. 8.4 


11.3 


12.7 


7.2 


9.0 


8.0 


9.0 


9.7 


10.0 


55 " 64 


(< 


. . 10.0 


15.4 


15.4 


11.5 


8.3 


9.0 


10.0 


11.7 


11.5 



These tables, although significant, show how inadequate available statis- 
tics are. 

Ventilation 

It may be stated without fear of contradiction that ventilation is the most 
important factor in relation to the health of workers. Defects of ventilation are 
the most important single cause of disease in industry. A statement of all that 
the term "ventilation" comprises when it is used by an industrial hygienist will 
make clear why it is of great significance. This holds equally true with reference 
to the school, because it is proper to consider the school as the industrial estab- 
lishment in which are engaged thousands who are acquiring knowledge and sub- 
mitting to character development; it is the business environment in which a con- 
siderable fraction of the lives of pupils and teachers is spent each year. It is 
commonly understood that ventilation implies the furnishing of an adequate supply 
of fresh air to a given room, factory, or other space. The industrial hygienist, 
however, is not concerned merely that the air which is furnished should be ade- 
quate in quantity, but also endeavors to have it free from contamination both 
before and after it enters a room. He desires also that dust, bacteria or the 
exhalations and emanations of the human body and the gases generated by the 
burning of gaslights be efifectively withdrawn ; that the air be of suitable temper- 
ature and humidity; that it be kept in motion so as not to stagnate, and that it 
should not be delivered in such manner as to drive it through a given space or 
room at a great velocity, thus creating a draft. The air supplied must be dis- 
tributed to all parts of the room. (This is especially important when mechanical 
ventilation is depended upon.) Natural ventilation through windows or skylights 
is bv far the best. If ventilation is obtained through natural means, that is, by 



Minimum Health and Sanitation Standards 9 

an adequate supply of windows, or skylights, it obviously implies that lighting 
will at the same time also be improved. When, because weather conditions are 
unfavorable, or structural arrangements are old or defective, or when for a 
variety of other reasons it is inadvisable to depend upon natural ventilation, one 
must re-enforce or replace it by resort to artificial methods of ventilation which 
depend upon fans to propel air into a room as well as to exhaust or remove con- 
taminated air. Frequently, artificial ventilation devices, even though they may 
have been installed at very great expense and at considerable trouble, have been 
found to be defective and impracticable in operation. Even when a mechanical 
system of ventilation is found necessary, it does not justify failure to open win- 
dows at all times when the weather conditions permit. 

The latter statement is in direct conflict with the views which have been held 
and enforced with reference to this subject, and as the result of which no one 
has been permitted to open windows while ventilating devices were in operation. 
Authority for this new view is, however, to be found in the special report made 
by the Divisional Committee on Heating and Ventilation of the Committee on 
Welfare of the Advisory Commission, Council of National Defense. This most 
important report was prepared by some of the foremost engineering authorities 
in the country. For the sake of emphasis and to overcome the harmful effects 
of wrong teaching which have been in force hitherto, it is desirable to repeat that 
the installation of a mechanical system of ventilation in rooms where the natural 
agencies for ventilation fail or are found insufficient, does not justify the old 
theory that the opening of windows in such rooms destroys the effectiveness of 
mechanical ventilation when the latter is in operation. From a hygienist's point of 
view, quoting the exact words of the report above referred to, "a. room cannot 
possibly have too many windows, nor can they be opened too often or too much 
when the external weather conditions permit." 

The report of the Divisional Committee on Heating and Ventilation of the 
Council of National Defense, which has already been referred to as an authori- 
tative guide, unfortunately does not make adequate provision for the amount of 
space to be furnished each occupant of a working place. A minimum of 400 cubic 
feet of air space per person should be insisted upon ; 600 cubic feet per person is 
the optimum. While it is our business to urge and compel children who cough 
or sneeze to cover up their mouths and noses with their handkerchiefs, we must 
nevertheless provide an adequate amount of space for each child in a classroom, 
so that it will be out of range of the discharges from a sneezing or coughing 
neighbor ; this is a necessary measure of protection against contact infection. For 
this purpose a minimum of 20 square feet of floor space is necessary for each 
child in a classroom. In apportioning the above amount of space, it is not intended 
that one should include in such computation those areas of a room which are not 
used for seating purposes ; the aisles, however, may be included in such computa- 
tion. 

For the purpose of adequate ventilation, rooms should be required to have a 
sufficient amount of window space so as to allow 21 square feet of window area 
for every occupant of the room; such windows, however, should open directly to 
outdoors. When the area of the window space for each occupant averages less 
than 21 square feet in a given room, it calls for the installation of a mechanical 
method of ventilation to supplement natural ventilation. When a mechanical 



10 Survey of tkc Schools by Teachers 

method of ventilation is necessary, the minimum amount of air space should be 
not less than 600 cubic feet of air per person per hour. If, for example, you 
have a classroom in which there are forty children, and you have only 700 square 
feet of window area instead of the optimum 840 square feet, then you have a 
deficiency of 140 square feet of window area in such room. For each square foot 
of window area that is lacking 100 cubic feet of air ought to be supplied for each 
occupant per hour. In other words, the mechanical ventilating device must com- 
pensate for the deficiency of window area in the room by supplying 140 times 100 
cubic feet of air for each of the 40 pupils. While the essentials of this calcula- 
tion concern only the engineer, they are offered in this connection to show that it 
is not sufficient merely to have an elaborate ventilating device in the room, but 
that the amount of air which is delivered must be accurately regulated. To be 
satisfied merely with the placing of a flag in front of each ventilator and to accept 
its fluttering as an indication that all is well, as has been the custom in many 
schools, is to place reliance on a very poor index of efficiency. Moreover, all 
locker rooms or wardrobe spaces should be adequately ventilated. 

In this connection, it should be pointed out that the ordinary method of stor- 
ing clothes is one which is not conducive to safety or good health, unless a proper 
amount of space exists between the clothing of each individual child, so that there 
may be no point of contact, and unless the space in which clothing is stored is 
well ventilated and well lighted. The sterilizing effect of sunlight not only upon 
the air of rooms which must be breathed by persons, but also upon the air of 
locker spaces must not be overlooked. 

The air must not be discharged with velocity at some point in a room to the 
inconvenience of some of its occupants but should be properly distributed through- 
out such room. Children who are seated near the windows in a room where 
natural ventilation is depended upon, should be guarded by a deflector — an inclined 
glass or wooden shield placed across the lower end of such windows, to deflect 
upward air currents entering the room so that they will not directly strike the 
children. In a similar fashion children who are seated near radiators or other 
heating devices may suffer from the effects of excessive heat. Such radiators 
should be properly insulated by non-conducting material (asbestos), and the 
heated air should be deflected upward, or, better still, the radiators or heating 
units should be so distributed as to be at a distance from children's seats. 

In a study made by Dr. S. J. Baker, the Director of the Bureau of Child 
Hygiene of the New York Department of Health, it was shown that in the 
closed-window room which was ventilated mechanically and kept at a temperature 
of about 58 degrees F., the rate of absences as the result of respiratory disease 
was 32 per cent, greater than in the open-window rooms which were naturally 
ventilated and kept at the same temperature. The best condition of health with 
respect to the prevalence of respiratory diseases is found to obtain in the open- 
window classes. At comparatively frequent intervals, as at the end of each period, 
all windows should be opened, preferably while the children are for the time 
being out of the room, or, if they must be kept in the room, while the children are 
exercising. Frequent changes of air are not only conducive to better health and 
comfort, but make for increased efficiency. 

Where mechanical methods of ventilation are depended upon, a "wet and 
dry bulb thermometer" should be supplied in each such room, and the teachers 



Minimum Health and Sanitation Standards 11 

should be made familiar with the reading of such thermometers so that they may 
estimate the relative humidity which should be at least 20 per cent, for any given 
temperature. A special chart or table is furnished with each such thermometer 
which enables the teacher after a very brief experience to make the necessary 
computation. For the average room, a temperature of 68 degrees F. is most desir- 
able from the standpoint of health. 

Lighting 

While proper lighting has not the importance of ventilation in relation to 
health, it is nevertheless of considerable significance among pupils and teachers 
because it prevents eye strain. The latter condition may be responsible for seri- 
ous suffering or discomfort which may be manifested by headache, irritability, 
lack of attention, fatigue, and be the cause of distant or so-called "reflex" dis- 
turbances which may be referred to the stomach or to other parts of the body. 
Dr. Ralph E. Wager of the Department of Biology, Northern Illinois State Normal 
School, in his study of the health of teachers calls attention to the marked prev- 
alence of defects of eyesight among them. There can be little doubt that a defec- 
tive system of lighting may not only react to make teachers and pupils irritable, 
restless and fatigued, but that it may be responsible for the backwardness of many 
pupils. It is not sufficient to depend on visual tests to discover such defects of 
eyesight; it is infinitely better to correct improper lighting. 

Seating arrangements should be of such character that the light falls over the 
left shoulder, and the arrangements of seats as well as the location of blackboards 
should be ordered so that they may not be placed at an angle which interferes 
with vision and produces a glare. It can be stated definitely that where natural 
or artificial lighting is used, the writing surfaces, whether blackboards or desks, 
should be neither too brilliantly lighted so as to reflect glares nor should there be 
marked shadows upon them. When artificial lights are employed, care must be 
taken that they should not flicker. Those who are in the habit of reading news- 
papers or books in the subways can testify to the blinding effects of flickering 
lights, and they will readily understand how this condition may cause serious eye- 
strain. 

In connection with adequate lighting, it is well to bear in mind the three 
requirements which are always insisted upon by leading engineers; namely, suf- 
ficiency, continuity of light, and diffusion. The sufficiency of light depends upon 
having an adequate window area. In order that there may be continuity, it is not 
only necessary to have a large enough window area for use on comparatively 
dark days, but there must be provided also one or two things — first a way of 
reducing light when it is excessively bright, and second, a way of increasing or 
supplementing it when the days are dark as at the close of day in the winter sea- 
son or on cloudy days. Lighting engineers emphasize the necessity of having 
rooms painted in light color, especially the ceilings and the upper portions of wall 
so that light will not be absorbed by dark surfaces, but be reflected and diffused 
throughout a room. The lower parts of walls should be painted dark to give 
relief to the eye. The diffusion of light calls also for the proper placing or dis- 
tribution of widows. 

If the requirements which were specified with reference to the area of win- 
dow space per person under the head of ventilation are complied with, the light- 



12 Survey of the Schools by Teachers 

ing requirements will at the same time be well met. Adequate natural lighting 
like natural ventilation is the best. However, we must be careful to prevent the 
glare of sunshine. In such cases, window shades, especially those which can be 
raised from below upward, are essential. Windows that have a northern exposure 
are best for the purpose of lighting. Those that have a southern exposure permit 
an excessive amount of sunshine to enter during the middle of the day in par- 
ticular, so that a heavy shade may have to be pulled down to cover the entire win- 
dow area, thus necessitating the use of artificial lighting during the early part of 
the day. 

When sunlight enters through the upper part of the window, it may be 
modified and made agreeable by having translucent window glass put into the 
upper sash, or by using light, translucent shades. The light entering through 
the upper part of the window diffuses over the widest area in the room. For this 
reason it is desirable, to have windows reach to as near the ceiUng as possible. 
The opaque or dark window shade is undesirable. Windows must be kept clean 
or they will prevent the entrance of an adequate amount of light even though the 
total area of window space is sufficient. 

If the windows look out upon a more or less confined space, and the light is 
intercepted or reduced by neighboring buildings much can be done to improve the 
lighting of such rooms by using what is known as prismatic glass. Prismatic glass 
is supplied in the form of corrugated glass, or has little prism-like projections 
which catch the light from any patch of sky which such window may face, and 
reflect or bend the light, and direct it into the room. While clean windows are 
always a most important essential for adequate lighting, they are of the greatest 
importance where prismatic or translucent glass is employed, because in these the 
light is already to a certain degree modified. 

When artificial lights are employed, they must be properly distributed so as 
to give light to all parts of the room ; they must be of adequate candle power, and 
the glare from such light which may fall upon polished desk-tops or other polished 
surfaces must be eliminated so far as possible by the use of dull paints and by the 
proper shielding or shading of the light. The lamps that are supplied must be kept 
clean or a great deal of the lighting power is lost. The use of ground glass electric 
bulbs or of ground glass globes has found great favor and is very desirable be- 
cause it prevents glare. Reflectors are extremely valuable in improving and dis- 
tributing the light thrown by lamps, but they are utterly useless if they are per- 
mitted to become unclean. It should also be remembered that a lamp which may 
give adequate candle power at the beginning becomes worn out with use, and the 
light therefore grows dimmer. 

If artificial light must be employed in a class room, it is advisable not to de- 
pend on a single light or a cluster of lights placed in the center of the ceiling, but 
if possible such lights or clusters should be distributed about the walls or ceiling so 
as to light up equally well all parts of the room. Any system of artificial lighting 
which permits marked shadows to be thrown upon any part of the working space 
or particularly upon the desk, is objectionable and indicates that an improper 
system is employed. When artificial lighting is employed in class rooms, the 
optimum amount of light for ordinary use should be four foot-candles. A foot- 
candle is the common unit of illumination, equal approximately to one watt, and is 
the amount of lighting effect produced upon an object by a standard candle held 



Minimum Health and Sanitation Standards 13 

at a distance of one foot; roughly, one can estimate whether the four foot-candles 
which ought ordinarily to be supplied for office work have been furnished, by the 
following very simple mathematical test: The candle-power furnished by a lamp 
or cluster of lamps is made the numerator ; the denominator is the square of the 
distance of such lamp or cluster of lamps, from the writing surface. For example, 
if a single lamp, or if a cluster of lamps in the center of the room, gives a light 
of 200 candle-power, then 200 is the numerator ; if the distance from the writing 
surface of a pupils' desk is the source of light is 10 feet then the square of the 
viistance is 100 feet, and the denominator is therefor 100. We then have a lighting 
power of 200/100 which equals 2 candle power ; in other words, we have only half 
the optimum illumination. The minimum which should be allowed for close appli- 
cation is 3 foot candles ; therefore, in the problem cited, the boy who sits 10 feet 
from a 200 foot candle light is receiving only one half of the optimum or two- 
thirds of the minimum lighting required. 

Drinking Water and Drinking Fountains 

All the standards that have been previously outHned have been in agreement 
with those which are laid down by authorities in the field of industrial hygiene 
for offices and similar work places. Continuing to apply such standards, it ought 
to be emphasized that drinking water ought to be readily accessible on the various 
floors of school buildings so that pupils and teachers may not have to lose time in 
going a considerable distance to slake their thirst. It is the general experience 
that where drinking water is not readily accessible, there is a tendency to repress 
the desire for water. The importance of drinking water in adequate amount from 
the health standpoint, as well as for the sake of comfort, need not be argued at 
this date. Nor need one dwell upon the dangers which lurk in the use of common 
drinking cups. 

The placing of drinking fountains in sufficient number so as to be readily 
accessible, is the best means of eliminating the use of the common cup. The latter 
is always to be found where the ordinary faucet is used to control the flow of water. 
The drinking fountain must, however, conform to a modern design, or it may give 
a false sense of security with respect to the transmission of disease. Such fountain 
must deliver a column of water that rises to a height of several inches. It should 
be furnished with a metal ring which prevents bringing the lips in close contact 
with the spout of the fountain. The column of water should not, however, be 
a vertical one, because it has been found by experience, that disease germs 
which may be on the lips of a person who uses the fountain, may remain 
supported at the top of the column of water for a very considerable period of time 
without being discharged into the drain. For this reason, the only proper type of 
drinking fountain is one which delivers an inclined column of water rising to a 
height of several inches, the inclination being about 15 degrees, so that any germs 
which may be caught in such a column of water are not kept dancing at the top, 
as is the case with the vertical water spout, but fall over into the drain promptly. 

Sanitation of the Toilet 

Toilets should be readily accessible. A great deal of unnecessary loss of time 
results when toilets are housed in a single unit at a considerable distance from the 
classrooms or offices. Moreover, constipation which is of such frequent occur- 



14 Survey of the Schools by Teachers 

ence among pupils, and among teachers whose life is a sedentary one, is en- 
couraged when the toilets are at a considerable distance. This is the common 
experience with large groups of people in industry and undoubtedly applies to the 
school population. 

It is needless to say that the sanitary standards in the construction and equip- 
ment of toilets should conform to those laid down for industry, that is, there should 
be a sufficient number of toilets for the school population ; they should be so con- 
structed that the ventilation, lighting and heating conform to the standards already 
laid down ; they should insure privacy, for it has generally been found that where 
there is no privacy, there is a tendency towards demoralization through the force 
of bad example and through the operation of "crowd" psychology. The ma- 
terial entering into the construction of the toilets should be impervious, and 
non-corrosive, and the construction should allow for proper drainage so that there 
may be no stagnation or accumulation and exposure of excrement. The windows 
and doors of the toilets should be particularly shielded during the spring and 
summer time by the use of screens to prevent the entrance of flies. 

It should be remembered that while one hundred and eleven typhoid carriers are 
known in the City of New York, it has been estimated that from 1 to 5 per cent, of 
those who have had typhoid fever remain typhoid carriers, discharging typhoid 
bacilli in their excrement for many years or for the rest of their lives. In the 
City of New York, we have had over twenty thousand recognized cases of typhoid 
fever which were reported to the Department of Health in the last ten years. 
It will be seen at a glance that there must be many more typhoid carriers, even 
if we limit ourselves to the cases which occurred in the last ten years, than are 
known to the Health Department. This may include many school teachers or 
pupils who recover or who may be healthy carriers. The entrance of flies which 
have access to excrement that is not promptly and effectively washed away or 
drained, is therefore a possible source of danger. The trough urinal or receptacle 
in toilets, or the so-called school sinks are a source of danger. Water-flushed 
and properly sewer-connected drainage for all toilet fixtures, together with 
screens at windows and doors, are very essential to prevent the possible spread of 
typhoid fever, and of other intestinal diseases through the medium of flies. 

Washing Facilities in Toilets 

The washing facilities in toilets should be adequate. Typhoid carriers are 
safe to others only to the degree in which they exercise care promptly and thor- 
oughly to wash their hands. Therefore, washing facilities should be available in 
toilets or near toilets, and also in other parts of the building so as to be readily 
accessible. A variety of communicable diseases are no doubt transmitted as the 
result of infection of the hands through contact with the nose and mouth, as well 
as through possible soiling with human excrement. 

The supply of washing facilities, and the installation of hot water regulated 
«o as to be of proper temperature, is extremely important from the standpoint of 
health to the individual pupil or teacher, and to those with whom they may come 
in contact. The supply of soap and towels in suitable quantity is also extremely 
important. Measures have been devised which permit one to provide these upon 
an economical and practical basis. Special paper towels, as well as properly 



Minimum Health and Sanitation Standards 15 

secured cloth towels, are available on the market. It is more economical to prevent 
disease by supplying proper washing facilities as well as to inculcate proper per- 
sonal habits in pupils, than it is to save money by omitting such facilities and 
fixtures. 

General Cleanliness 

Reference has already been made to the economy which results from keeping 
windows and lighting fixtures clean. The general cleanHness of floors and all 
furniture hardly needs to be alluded to in the light of modern knowledge. It is 
important that dry dusting and dry sweeping be eliminated from all schools, no 
matter at what hour performed, but especially before the opening of school or at 
any time during the school day. Dry dusting and sweeping tends only to scatter 
dust, and is not effective for its collection and disposal. Mopping of the floors 
with oil cloths or with damp cloths or so-called "settlers," like oil particles or wet 
sawdust, is essential, and this should be done when the school has been completely 
emptied of pupils and teachers. In this connection, reference should be made to 
the chalk dust which is set free in class rooms or which results from the cleaning 
of erasers. This should be prevented so far as possible by the use of moist cloths 
for erasing chalk marks. While this may involve loss of time, it is, however, 
profitable in the long run. Pupils should never be asked to clean blackboard erasers. 

Rest Room and Lunch Room 

In modern industry, it has been found not only desirable but necessary and 
economical, to provide a lunch room where those who are unable for a variety of 
reasons to secure luncheon at their homes or in restaurants, may find suitable and 
sanitary quarters to be used as lunch rooms. While this is not so important in 
the school as it is in certain branches of industry, nevertheless, in the interest of 
good housekeeping and comfort, it is desirable so far as possible to have places 
which are available for use as lunch rooms for pupils and teachers. While a 
properly fitted up lunch room which has come to be recognized as an essential in 
welfare work for those employed in industry, may be difficult to obtain in the 
schools, there can be no question whatever that a rest room suitably fitted up to 
permit pupils and teachers, who may be temporarily indisposed or ill, to rest, is 
necessary as well as desirable. Many absences which formerly occurred in in- 
dustry because adequate facilities for rest or for emergency medical and nursing 
relief were lacking, have now been eliminated in industrial establishments which 
have regard for the health of employees. This has been done by the installation 
of rest rooms where nursing care or quiet can be obtained and where indispositions 
are promptly ministered to with the least degree of suffering to those so affected 
and with the ultimate prevention of more serious developments. To use the ver- 
nacular, rest rooms have been found to be a "paying proposition," 

Unfortunately, it is not possible in the brief compass of an address of this 
character, to dwell upon the necessity for maintaining proper health in pupils and 
teachers by the observation of rules of personal hygiene which are extremely im- 
portant, and which, if violated, tend to weaken resistance or favor the development 
of disease. Much could be said about the value of an adequate and proper diet, 
faulty habits of eating, as well as the use and abuse of exercise, the need for rest 
periods, the value of adequate sleep, the avoidance of exposure to excessive heat and 



16 Survey of the Schools by Teachers 

cold at various seasons of the year, and the relation of proper methods of dressing 
to such conditions. Attention to these details is required in the school, as well as 
outside of the school. The health aspects of recreation and many other topics 
which are directly related to personal health, might be profitably dwelt upon, but 
this address was not intended to emphasize these things. 

By way of conclusion, it is desirable to refer again to the necessity for ade- 
quate medical supervision and study of teachers, with a view to ascertaining their 
physical condition and fitness at the time of their entrance into the profession, and 
the casualties, and damages to health which may be recorded at various stages 
of their career in the profession, with a view to determining more accurately than 
has been done in the admittedly limited studies which have been made heretofore. 
There can be no doubt of the scientific value of studies which concern themselves 
not only with the results of medical examinations made at the time of entrance 
into the profession and periodically repeated examinations thereafter, but also with 
careful sickness reports and follow-up, and medical examinations to record the 
character, duration and the ultimate effects of all illnesses whether deemed trivial or 
important, conducted over a considerable period of time. In this way alone, will it 
be possible to obtain knowledge of scientific value and importance in safeguarding 
the health of teachers, and protecting pupils from the physical and mental effects 
of sickness, to which teachers may be subject. 

BIBLIOGRAPHY 

Physical Disability of New York City School Teachers — Louis I. Dublin, Ph.D. 
Ad-interim Report of an Investigation of the Absences of New York School Teachers 
During the School Year 1913-1914 — Dr. Oswald Schlockow. 

Health of the School Teacher — Dr. Ralph E. Wager (published in the Journal of 
Industrial Hygiene, September, 1920). 

Report of Commission on Welfare of Teachers — T. D. Wood, New York State Teachers 

Association, 1916. 
The Teacher's Health — L. Terman. 

Diseases of Occupation and Vocational Hygiene — Kober & Hanson. 
Classroom Ventilation and Respiratory Diseases Among School Children — S. Josephine 

Baker, M.D., Department of Health, New York. 
Report of Divisional Committee "Code of Lighting" of the Committee on Labor, 

Advisory Commission, Council of National Defense — Bulletin No. 3 of Welfare 

Work Series, Government Printing Office. 
Report of the Divisional Committee on Heating and Ventilation of the Committee on 

Labor, Advisory Council of National Defense — Bulletin No. 4 of Welfare Work 

Series, Government Printing Office. 
Tentative Syllabus on Hygiene for Elementary Schools — Approved by the Board of 

Superintendents, Department of Education, New York, September, 1916. 



